Low flow or no flow after CPAP

Abstract

Nasal continuous positive airway pressure (CPAP) is routinely used to treat mild respiratory failure in spontaneous breathing infants and to wean infants from mechanical ventilation. But how should an infant be weaned from CPAP? In the not too distant past, this routinely was done with nasal cannula flow or a hood for infants requiring oxygen. CPAP was simply removed for infants not requiring supplemental oxygen. More recently, the use of “room air flow,” generally with unheated and poorly humidified gas, has become very common. This supplementary flow of room air is given by nasal cannula, and then is gradually “weaned” by decreasing the flow. The physiological effects of delivering low flows of air by nasal cannula are suspect, but its benefits are widely accepted. In this issue of The Journal, O'Donnell et al report a small trial of weaning stable preterm infants from CPAP using low flow by nasal cannula or no flow/no cannula. The authors found no benefit of the nasal cannula flow for decreasing the need to reinstitute CPAP. Because 30%-40% of infants went back on CPAP, this population of infants would seem appropriate for the evaluation of flow relative to no support. The trial suggests that a large waste of respiratory therapy resources and nursing time could be avoided by not using room air flow after an infant is deemed ready for a trial off CPAP. Article page 79▶ The NOFLO Trial: Low-Flow Nasal Prongs Therapy in Weaning Nasal Continuous Positive Airway Pressure in Preterm InfantsThe Journal of PediatricsVol. 163Issue 1PreviewTo determine if low-flow nasal prongs therapy with room air, compared with no treatment, facilitates weaning from nasal continuous positive airway pressure (NCPAP) in very low birth weight (VLBW, birth weight <1500 g) infants. Full-Text PDF